Results
Table 1. EXAMINATION OF URINE SAMPLES
Physical Appearance | Result of Specimen | Remark | |||
A | B | C | MY | ||
Colour | Light yellow | Light yellow | Light yellow | Yellow | Urine colour indicates how concentrate is our body urine. The darker the yellow colour the more concentrate is our body urine.The normal urine colour is pale yellow. |
Odour | pungent | Fruity smell | Agar smell | Mild Ammonia smell | Abnormal smell of the urine can implies health problem. |
Specific Gravity, SG | 1.015 | 1.005 | 1.005 | 1.005 | Normal value of specific gravity ranges from 1.000-1.025. At end stage renal failure, our kidney loss their ability to concentrate and dilute the urine output, so usually the urine SG is fixed at 1.010 regardless of fluid intake. |
pH | 6 | 7 | 6 | 7 | Varies form 4.8-7.4. But usually the pH of the urine is neutral, 7. Metabolic acidosis, ketoacidosis (diabetes), high protein diet can lead to acidic urine. |
Chemical Analysis | |||||
Leukocytes | -ve | -ve | -ve | -ve | Presence of leukocytes may indicate urinary tract infection |
Nitrite | -ve | -ve | +ve | -ve | Presence of nitrite may indicate urinary tract infection as well |
Protein (albumin) | Normal | 1+ | -ve | -ve | Proteinuria which is the presence of protein in urine may indicate some renal disease example nephrotic and nephritis syndrome |
Glucose | 4+ | Normal | -ve | -ve | Diabetes patient can present urine with high level of glucose. |
Ketones | -ve | 2+ | -ve | -ve | Presence of ketone may indicate diabetes complication, abnormal nutritional conditions, metabolic abnormalities |
Urobilinogen | Normal | -ve | Normal | Normal | Presence of urobilinogen may indicate some liver diseases or liver damage |
Bilirubin | -ve | Normal | 1+ | 1+ | High level of bilirubin indicate s liver disease |
Blood Erythrocytes / haemoglobin) | 4+ | 4+ | -ve | -ve | Presence of erythrocytes in urine is an indication of renal dysfunction and urinary tract infection. |
Results | Diabetes patient (with haematuria) | Renal failure patient | Healthy person | Healthy person | |
Part II. Microscopic Examination of Urine Sediment
[Examinaion of colour photographs of slides of urine sediments]
In the clinical situation, a positive result of the urinalysis with the multitest strips in Part 1 is normally confirmed with microscopic examination of the urine sediment. A positive test from the test strip of leukocytouria, haematuria, proteinuria, nitriuria or a pH > 7 is indicative of targeted microscopic examination and bacteriological investigation of the urine.
Analysis of urine sediment consists of a microscopic examination of the precipitate of a centrifuged specimen of native urine. The elements investigated for are cells, casts and individual microorganisms. This test is not standardized and does not give quantitative results.
Test material [normal procedure followed to prepare a sediment sample]
- Midstream urine of the morning urine sample is collected without preservatives, not more than 2 hours before the test
- 10ml of the sample is well-shaken and centrifuged for 5 min at about 400 g (1500 revolutions per min with a radius of 15 cm)
- The supernatant is pipetted out carefully without swirling up the sediment
- The sediment is then resuspended in urine running back down the tube walls
- A small droplet (about 20L) of the sediment is placed in the middle of a clean microscope slide.
- A cover slip is then carefully placed over it, avoiding the formation of air bubbles.
- Using a x10 objective, the sample is checked for casts parallel to the edges of the cover slip.
- Using a x 40 objective, at least 10 fields are examined.
- The results are documented as follows: [not required in this laboratory practical]
Cells (X40 objective) | |
(+) | 0-1 per field |
+ | 1-5 |
++ | 6-15 |
+++ | 16-50 |
Abundant | >50 |
- Examine the colour photographs of the following microscopic slides on urine sedimentation and record the observations by drawing the characteristic features in Table 2. in the cell provided. Only draw in the spaces where more than 3 lines of spaces are provided.
Table 2. Microscopic urine Sediment Examination *
1 | Group of 4 squamous epithelial cells | Largest cell in the urinary sediment |
2 | Squamous epithelial cells, transitional epithelial cells | |
8 | Three epithelial cells (of tubular origin) | Cluster at cell and cylindrical shape |
14 | Morphologically normal, biconcave erythrocytes | |
15 | Morphologically normal erythrocytes | Alkaline or hypotonic urine RBC swells |
18 | Morphologically normal erythrocytes (in hypotonic urine: red cell “ghosts” | |
22 | Dysmorphic erythrocytes | |
25 | Polymorphonuclear neutrophils | Have segmented nucleus |
26 | Leukocytes, yeasts | Opportunistic infection with C. albicans |
28 | Leukocytes, erythrocytes, bacteria | |
30 | Leukocytes, triple phosphate, bacteria | |
31 | Hyaline cast | |
32 | Small white blood cell cast | Pathognomonic of pyelonephritis |
33 | White blood cell cast | |
34 | Red blood cell cast | |
37 | Epithelial cast | Formed form desquamated tubular epithelial cells |
40 | Granular cast | |
45 | Group of yeast cells |
Discussion
From the data obtained from the urinalysis,
1. Sample MY has the following characteristics:
There is no abnormality in my dipstick test result, except a little presence of bilirubin.
2. Sample A has the following characteristics
· Abnormal high in glucose level,
· Highest specific gravity among the four samples tested. (but still within normal range)
· Slightly acidic urine pH.
· Presence of erythrocytes in urine.
· Presence of protein in urine but still within normal range
High glucose level is due to the insufficient of hormone insulin which is in charge of the conversion of glucose to glycogen. The reabsorption process of glucose fail to compensate the large amount of glucose in the urine. High specific gravity of urine is due to the presence of glucose in the urine which increases the concentration and osmolarity of urine. Slightly acidic urine can be due to the high level of uric acid in the blood of diabetic patient. Diabetic patient especially those suffering from type 2 diabetes disease have a higher risk of developing uric acid kidney stone. This kidney stone may damage the kidney components ,leading to bleeding and haematuria. Besides that, chronic dysregulated blood glucose in diabeteic patient is toxic to cells of kidney’s vascular endothelium which passively assimilate glucose ,in addition to this direct glucose-induced damage excessive glucose of diabetic patient can also be converted into osmologically-active metabolites such as sorbitol leading to hypertonic lysis of kidney endothelium cell. This lead to haematuria and proteinuria, but overall the protein level in urine is still considered as normal.
Since urine of diabetic patient is rich in glucose and nutrients, urinary tract infection can easily develops, which can lead to haematuria as well.
Therefore the patient might suffer from diabetes mellitus and mild kidney damage secondary to the underline diabetes mellitus.
3. Sample B has the following characteristics
· Fruity smell urine
· presence of ketone,
· presence of protein, and erythrocytes in the urine.
Therefore the patient is probably suffering from kidney failure for example glomerulonephritis and tubular damage. Glomerulonephritis is a renal disease (usually of both kidneys) characterized by inflammation of the glomeruli, or small blood vessels in the kidneys. The inflammation damages the kidney and capillaries leading to the leakage of protein and red blood cells into the urine. The presence of ketones in urine can be due to the degradation of fat by body for energy supply when the body is lacking of carbohydrate intake, for example the patient may had underwent fasting or was starving before the urine is collected for analysis. Ketone contributes to the fruity smell of urine.
4. Sample C has the following characteristics
Other than positive nitrite and bilirubin test, all other examination shows normal result. The presence of nitrite and bilirubin can be due to contaminations that occur during collection or storage of subject’s urine sample. The slightly acidic pH of urine might be due to the consumption of diet which is high in protein. This will increase the production of uric acid which is slightly acidic in nature. So this person if continue on with this high intake of protein might eventually suffering from arthritis or kidney stone.
5.Microscopic examination of urine sediment which contain abundant :
q Leukocytes indicate : urinary tract infection, urinary obstructions, kidney failure, acute glomerulonephritis
q Erythrocytes indicate : urinary tract infection, blockages and stones of the renal system, renal disease, glomerularnephritis.
q Polymorphonuclear neutrophils indicate: urinary tract infection
q Yeasts: urinary tract infection
q Bacteria: urinary tract infection
q Phosphate crystals : alkaline urine
q White blood cell casts : glomerulonephritis, interstitial inflammation, pyelonephritis
q Red blood cell casts : glomerulonephritis, acute tubular injury
q Hyaline cell casts: under normal condition a few hyaline cast can be found
Discussion
Sample A :
the colour of this urine is light yellow this is the normal colour of urine. The urine has a pungent smell. The specific gravity for this sample is 1.015, The pH in the sample is 6 , slightly acidic but still within normal range. Glucose is detected in the urine indicating that the patient is suffering from diabetes. Red blood cells is also detected in the urine. Under microscopic view; hyaline casts were saw, but this is considered normal.
High glucose level in sample A is due to the insufficient of hormone insulin which is in charge of the conversion of glucose to glycogen. Besides that ,the reabsorption process of glucose in tubules had failed to compensate with the large amount of glucose level in the urine High specific gravity of urine is due to the presence of glucose in the urine which increases the concentration and osmolarity of urine. Slightly acidic of the urine can be due to high level of uric acid in the blood of diabetic patient. Diabetic patient especially those suffering from type 2 diabetes disease is at a higher risk of developing uric acid kidney stone. This kidney stone may damage the kidney components ,leading to bleeding and haematuria. Besides that, chronic dysregulated blood glucose in diabeteic patient is toxic to cells of kidney’s vascular endothelium ,in addition to this direct glucose-induced damage excessive glucose of diabetic patient can also be converted into osmologically-active metabolites such as sorbitol leading to hypertonic lysis of kidney endothelium cell. All these lead to haematuria and proteinuria, but overall the protein level in urine is still considered as normal.
Sample B :
the colour of this urine is light yellow, this is a normal colour of urine. The urine has a fruity smell. The specific gravity for this sample is 1.005, it is within the normal range. The pH in the sample is 7 indicating that the urine is neutral. Protein and erythrocytes were present in the urine indicating kidney failure in our patient. The presence of ketone in the urine may indicate abnormal nutritional condition such as fasting, anorexia, high protein diet, low carbohydrate diets, and starvation. Patient B might have underwent fasting or diet which is low in carbohydrate .Under microscopic view; a lot of hyaline casts and erythrocytes were observed. Large amount of hyaline cast may be due to high amount of proteins which released during proteinuria. This indicates kidney damage or kidney disease in patient B.
Sample C :
the colour of this urine is again light yellow, it is a normal colour. The urine has a mild ammonia smell. The specific gravity for my sample is 1.005 it is in the normal range. The pH in the sample is 6 indicating that the urine is slightly acidic. This could be due to high consumption of protein in the patient diet. The sample indicate negative for all of the chemical analysis except for the slight presence bilirubin and nitrile, these can be due to contamination which occur during improper collection and storage of urine.. Under microscopic view normal level of hyaline casts was seen. This is normal.
My urine is yellow, this may be due to the lacking of water consumption in my daily life resulting in highly concentrated urine which is darker in colour. My urine has a mild ammonia smell which is normal. The specific gravity for my sample is 1.015 it is in the normal range. The pH in the sample is 7 indicating that my urine is neutral. My sample indicated negative result for all of the chemical analysis except for the slight presence of bilirubin in urine, this might be due to experimental error and contamination since during the testing we were using the same tissue paper for all the dip stick used. Under microscopic view normal hyaline cast ware also observed.
Conclusion
Patient A is suffering from diabetes mellitus.
Patient B is suffering from kidney failure
Patient C and I are healthy people.
Renal System
Urinalysis & Microscopic Urine Sediment Examination
Question and Answer Session (at the end of the Lab Class)
1. Give 3 reasons why great care must be taken in the collection and storage of the urine sample?
· Mid-stream is taken during collection because mid –stream of urine give the actual osmolality and materials in patient urine. The urine collected before mid-stream may be dirty and contaminated due to the presence of bacterial and dirt outside the urethra and those collected after midstream can be too concentrated.
· Proper storage of sample urine is needed to avoid contamination of urine sample and to prevent the entry of bacterial from environment into our sample.
· Proper storage of sample urine also prevent the breakdown or deterioration of any components of urine collected from patient body. Refrigeration is needed for urine which fail to be sent for analysis within 2 hours after sample collection .
2. What would you interpret when a sample shows positive for:
I. glucose? Patient is having diabetes mellitus
II. protein? Patient is having kidney disease, for example nephrotic syndrome.
III. ketones? Patient is having diabetes, anorexia, or may be due to fasting and starvation,
IV. bilirubin? Patient is having liver disease such as liver damage and hepatitis B.
V. leukocytes? Patient is having kidney disease or infection of the urinary tract
VI. blood (erythrocytes /hemoglobin)? Patient is having kidney disease
VII. yeasts? Patient is having urinary tract infection.
VIII. bacteria? Patient is having urinary tract infection.
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